Ca lung Dr. D.P. Singh Professor, Surgery.. Primary lung cancer – risk factors Cigarette smoking...
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Transcript of Ca lung Dr. D.P. Singh Professor, Surgery.. Primary lung cancer – risk factors Cigarette smoking...
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Ca lung
Dr. D.P. Singh
Professor, Surgery.
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Primary lung cancer – risk factors Cigarette smoking
Number of years Number of packs Passive smoking
Atmospheric pollution Occupational (radioactive ore, chromium
mining, asbestos, arsenic) Previous h/o TB with smoking
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Pathological types
Small cell lung carcinoma (oat cell carcinoma)
Non Small cell lung carcinoma SCLC:NSCLC :: 1:4
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Histological classification
Small cell lung cancer Non small cell lung cancer
Adenocarcinoma 25-40% Large cell undifferentiated 10-20% Squamous cell carcinoma 30-40% Bronchoalveolar carcinoma 5%
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Clinical features
Depend on Site of lesion Invasion of neighboring structures Extent of metastases
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Clinical features
Symptoms Hemoptysis Cough or changed cough Dyspnoea, wheezing Pleural effusion Severe localized pain suggests chest wall invasion Invasion of mediastinum – hoarseness, dysphagia, SVC
obstruction Pancoast’s syndrome – invasion of brachial plexus Clubbing Small cell carcinoma may cause myopathies.
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Paraneoplastic syndrome with lung cancer Endocrine
Hypercalcemia Cushing’s syndrome SIADH Carcinoid syndrome Gynaecomastia Hypercalcitonemia Elevated GH Elevated prolactin, FSH, LH Hypoglycemia hyperthyroidism
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Paraneoplastic syndrome contd. Neurologic
Encephalopathy Subacute cerebellar degeneration PML Peripheral neuropathy Polymyositis Autonomic neuropathy Lambert eaton syndrome Optic neuritis
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Paraneoplastic syndrome contd. Skeletal
Clubbing Pulmonary hypertrophic osteoarthropathy
Hematologic Anemia Leukemoid reaction Thrombocytosis Thrombocytopenia Eosinophilia Pure red cell aplasia DIC
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Paraneoplastic syndrome contd. Cutneous
Hyperkeratosis Dermatomyositis Acanthosis nigricans Hyperpigmentation
Other Nephrotic syndrome Hypouricemia Secretion of VIP with diarrhea Anorexia and cachexia hyperamylasemia
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Diagnosis
3 aspects Detecting the primary lesion Tissue diagnosis Staging
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Investigations
Chest radiography Computerized tomography MRI EUS PET Bronchoscopy Sputum cytology CT guided biopsy Mediastinoscopy Mediastinotomy Assessment of functional status - spirometry
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Cervical Mediastinoscopy
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Anterior mediastinoscopy
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Staging : T: Tumor status
TX - Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washing but not visualized by imaging or bronchosocopy
T0 - evidence of primary tumor Tis - Carcinoma in situ T1 - 3 cm or less without invasion of visceral pleura T2 - >3 cm or any size with associated atelectasis or obstructive
pneumonitis, or invasion of visceral pleura T3 - Any size with direct extension into chest wall, diaphragm,
mediastinal pleura without involvement of great vessels or vital mediastinal structures and extent of bronchial spread with 2 cm of, but not involving, the carina
T4 - Any size with invasion of the heart or mediastinal vital structures or carina, malignant pleural effusion
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N: Nodal involvement
NX - Regional lymph nodes cannot be assessedN0None
N1 - Peribronchial or ipsilateral hilar lymph nodes
N2 - Ipsilateral mediastinal lymph nodes, including subcarinal
N3 - Contralateral mediastinal or hilar lymph nodes, ipsilateral or contralateral scalene or supraclavicular lymph nodes
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M: Distant metastases
MX - Presence of distant metastases cannot be assessed
M0 - None M1 - Distant metastases present
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Stage grouping
0 Carcinoma in situ IA
T1N0M0 IB
T2N0M0 IIA
T1N1M0 IIB
T2N1M0 T3N0M0
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Stage grouping
IIIA T3N1M0 T1-3 N2M0
IIIB T4, Any N, M0 Any T, N3, M0
IV Any T, any N, M1
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Treatment
Early stage disease (stage I and II) Surgery
Locoregional advanced disease (T3N1 and above)
Surgery – limited role Chemotherapy Radiotherapy
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Surgical management
Lobectomy Pneumonectomy Thoracoscopic lung resection
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Complications of lung resection Bleeding Respiratory infection Persistant air leak Bronchopleural fistula
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Other treatment modalities
Radiotherapy Chemotherapy